Antimicrobial Resistance in Somalia: Surveillance Gaps, Stewardship Barriers, and One Health Priorities

This narrative review examines antimicrobial resistance (AMR) in Somalia, with emphasis on surveillance gaps, stewardship barriers, and One Health priorities. Peer-reviewed and selected grey literature published between 2010 and March 2026 was reviewed using major bibliographic databases and relevant policy sources. The available Somalia-specific evidence remains limited, heterogeneous, and concentrated mainly in facility-based studies from urban settings, particularly Mogadishu. Existing findings indicate concerning resistance patterns among major bacterial pathogens, while national surveillance systems, laboratory capacity, quality assurance, antimicrobial stewardship structures, and regulatory oversight remain underdeveloped. Evidence from animal health, food systems, and environmental sectors is also sparse, limiting operational implementation of a One Health response. Strengthening AMR control in Somalia requires phased investment in sentinel surveillance, microbiology and antimicrobial susceptibility testing, antimicrobial stewardship, pharmaceutical regulation, infection prevention and control, water, sanitation and hygiene, and multisectoral coordination. Addressing AMR in Somalia will depend on both AMR-specific interventions and broader health-system strengthening.